Provider Demographics
NPI:1891974911
Name:MUSTANG CHIROPRACTIC
Entity type:Organization
Organization Name:MUSTANG CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-760-4555
Mailing Address - Street 1:11500 HIGHWAY 7
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5173
Mailing Address - Country:US
Mailing Address - Phone:612-760-4555
Mailing Address - Fax:952-933-2673
Practice Address - Street 1:11500 HIGHWAY 7
Practice Address - Street 2:SUITE 201
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5173
Practice Address - Country:US
Practice Address - Phone:612-760-4555
Practice Address - Fax:952-933-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDC3629OtherMN STATE LIC#
V73159OtherUPIN#
01B13MUOtherBCBS GROUP#
01B14WOOtherBCBS ID#
1790838332OtherINDIVIDUAL NPI#
562OtherHSM ID#
01B14WOOtherBCBS ID#